A pacemaker is a small electronic device surgically implanted to regulate the heart’s rhythm through timed electrical pulses. It consists of a pulse generator, which contains a battery and electronics, and leads that deliver impulses directly to the heart muscle. Since the device is implanted, questions regarding its safety are common. This article clarifies the risks associated with pacemakers compared to the significant life-saving benefits they provide.
Necessity Versus Risk: The Rationale for Implantation
Pacemakers treat conditions like bradycardia (slow heart rate) or heart block, where electrical signals are blocked. When the heart rate is too low, the body does not receive enough blood, causing symptoms like dizziness, shortness of breath, or fainting. For most patients, the underlying heart condition poses a greater risk than the implanted device.
The decision to implant is based on a careful assessment where the necessity of restoring a stable heart rhythm outweighs the potential for complications. By ensuring the heart beats at a steady, functional rate, the device alleviates symptoms and prevents serious consequences like sudden cardiac events. Restored heart function allows individuals to regain a more active lifestyle.
Immediate Risks Associated With the Procedure
Incision Site Risks
Immediate concerns relate primarily to the surgical procedure, which is typically performed under local anesthesia. As with any surgery, there is a risk of infection at the incision site, occurring in about one percent of patients. Bleeding or the formation of a hematoma, a collection of blood under the skin, can also occur at the surgical site.
Lead Placement Risks
During the process of threading the leads through a vein toward the heart, there is a small possibility of accidentally puncturing the lung, causing a collapsed lung (pneumothorax). This complication is rare and often resolves on its own, though it may occasionally require a chest drain. Another concern is temporary dislodgement of the leads from their intended position within the heart chambers. Patients are advised to restrict arm movement on the side of the device for several weeks to allow the leads to secure themselves to the heart tissue.
Managing Long-Term Device Safety and Interference
Long-term safety concerns include electromagnetic interference (EMI), lead integrity, and battery longevity. Pacemakers are highly shielded, but strong external electromagnetic fields can interfere with function, causing the device to misread signals or revert to a safety pacing mode. Sources of significant EMI include large industrial equipment, such as arc welders, high-tension wires, or powerful magnets, which should be avoided.
Most common household appliances, including microwave ovens, electric blankets, and computers, do not pose a risk to modern pacemakers. The leads connecting the pulse generator to the heart can rarely fracture or fail over many years due to repeated movement. The pulse generator’s battery has a finite lifespan, typically lasting between five and 15 years. Battery depletion is monitored routinely, and a replacement procedure is scheduled before the battery runs out.
Patient Precautions and Monitoring
Maintaining long-term safety requires patient adherence to precautions and regular monitoring. Follow-up appointments, often scheduled every three to six months, monitor battery life, assess lead function, and ensure programmed settings are correct. Many modern devices allow for remote monitoring, where the pacemaker sends data wirelessly to the clinic, enabling prompt detection of functional changes.
Certain medical procedures require specific attention, particularly Magnetic Resonance Imaging (MRI) scans, due to the powerful magnets involved. Newer pacemakers are often MRI-compatible, but older devices require specific programming adjustments before and after the scan to prevent malfunction.
When using a cell phone, it should be kept at least six inches away from the pacemaker site, using the ear opposite the device to minimize interference. Security systems, such as airport metal detectors, are generally safe, but the device may trigger the alarm. Patients should carry their identification card and avoid lingering near the equipment.